Benign intermittent gastric outlet obstruction in an elderly: Endoscopic management and brief review

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeksduration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction Polypectomy was done with complete relief of symptoms .She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric out let obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review ispresented.Key words:Inflammatory polyp, Gastric outlet obstruction

Evaluation of combined disc method for the detection of metallo-β-lactamase producing Gram negative bacilli

Aims: Infections due to metallo-β-lactamase (MBL) producing Gram negative rods are a cause of high mortality and morbidity. Early detection by an economical and accurate method may improve patient outcome. This study was aimed to evaluate the diagnostic accuracy of combined disc method for MBL detection by comparing it with MBL-Etest.Methodology and Results: This cross-sectional, validation study was carried out in the Department of Microbiology, Army Medical College, National University of Sciences and Technology, Rawalpindi, over a period of six months. A total of 52 non-duplicate Gram-negative rods isolated from the routine clinical specimens and found resistant to meropenem/imipenem on Kirby Bauer Disc Diffusion method were subjected to two tests for metallo-β-lactamase detection. One was combined Disc test using imipenem with Ethylene Diamine Tetraacetic Acid (EDTA), where a strain showing an increase in zone of inhibition of combined disc of ≥ 7 mm as compared to imipenem alone, was considered as MBL producer and the other one was MBL-Etest for which results were interpreted as per manufacturer’s guidelines. Combined disc method for MBL detection was found to have a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.5%, 100%, 100%, 92% and 98%.Conclusion, Significance and Impact of study: Combined disc method is an economical and reliable method for metallo-β-lactamase detection which can be used routinely in any laboratory

Detection and Antibiotic Susceptibility Pattern of Biofilm Producing Gram Positive and Gram Negative Bacteria Isolated From a Tertiary Care Hospital of Pakistan

Microorganisms adhere to non-living material or living tissue, and form biofilms made up of extracellular polymers/slime. Biofilm-associated microorganisms behave differently from free-floating bacteria with respect to growth rates and ability to resist antimicrobial treatments and therefore pose a public health problem. The objective of this study is to detect the prevalence of biofilm producers among Gram positive and Gram negative bacteria isolated from clinical specimens, and to study their antimicrobial susceptibility pattern. The study was carried out from October 2009 to March 2010, at the Department of Microbiology, Army Medical College/ National University of Sciences and Technology (NUST), Rawalpindi, Pakistan. Clinical specimens were received from various wards of a tertiary care hospital. These were dealt by standard microbiological procedures. Gram positive and Gram negative bacteria isolated were subjected to biofilm detection by congo red agar method (CRA). Antimicrobial susceptibility testing of those isolates, which showed positive results (slime production), was done according to the Kirby-Bauer disc diffusion technique. A total of 150 isolates were tested for the production of biofilm/slime. Among them, 81 isolates showed positive results. From these 81, 51 were Gram positive and 30 were Gram negative. All the 81(54%) slime producers showed reduced susceptibility to majority of antibiotics. Bacterial biofilms are an important virulence factor associated with chronic nosocomial infection. Detection of biofilm forming organisms can help in appropriate antibiotic choice

Economic evaluation of smart well technology

The demand of oil and gas resources is high and the forecasts show a trend for higher requirements in the future. More unconventional resource exploitation along with an increase in the total recovery in current producing fields is required. At this pivotal time the role of emerging technologies is of at most importance. Smart or intelligent well technology is one of the up and coming technologies that have been developed to assist improvements in field development outcome. In this paper a comprehensive review of this technology has been discussed. The possible reservoir environments in which smart well technology could be used and also, the possible benefits that could be realized by utilizing smart well technology has been discussed. The economic impact of smart well technology has been studied thoroughly. Five field cases were used to evaluate the economics of smart well technology in various production environments. Real field data along with best estimate of smart well technology pricings were used in this research. I have used different comparisons between smart well cases and conventional completion to illustrate the economic differences between the different completion scenarios. Based on the research, I have realized that all the smart well cases showed a better economic return than conventional completions. The offshore cases showed a good economic environment for smart well technology. Large onshore developments with smart well technology can also provide a lucrative economic return. These situations can increase the overall economic return and ultimate recovery which will assist in meeting some of the oil demand around the globe

Model of Transformational Leadership, Risk Management Factors Influencing on Law Performance

The ability of law enforcement organisations to effectively combat crime depends on their use of innovation and workplace transformation. When the need for change in law enforcement organisations' daily operations becomes more and more apparent, transformational leadership has been shown to be extremely beneficial in risk management and enhancing police performance. The right strategy for effective policing development and improving police officer performance is established by this leadership style. The Dubai Police Department's performance in enforcing the law suffers in the absence of effective risk management and transformational leadership, potentially jeopardising the relationship between officers and all departments. As a result, this study created a model outlining the causal links between risk management and transformational leadership and the effectiveness of law enforcement. This study was quantitatively conducted, collecting 381 completed responses that were statistically analysed using SPSS and AMOS. The responses gathered during the data collection process were verified by the reliability analysis. Using fit index parameters to define the relationship between risk management and transformational leadership and law enforcement performance, AMOS analysis revealed that the developed model is satisfactory. The police department will be able to effectively manage risk with the help of this finding in order to reduce crime and create a security plan for the officers

Exploratory Analysis of Risk Management Process of UAE Police Department

Risk control and management are becoming increasingly important in many organisational operations. It goes beyond the business sector to include security organisations like police departments. The fact that police officers engage in a wide range of daily activities that expose them to a variety of potentially hazardous situations Police risk management includes both physical and financial aspects. Risk identification is the first step in the risk management process, followed by risk analysis, risk evaluation, and risk treatment. According to the literature, the Dubai Police Department has no framework in place to fully manage risks and evaluate the effectiveness of police operations. Early warning systems are critical for detecting potential severe RM because police departments must rely on them to manage risks and keep track of any potential new risks. As a result, the UAE police department's risk management strategy was investigated in this paper. It classified the data collection process using exploratory factor analysis, which was a quantitative approach. A self-administered survey yielded 381 valid questionnaires from Dubai Police Department officers. The study's findings revealed that risk identification, risk analysis, risk evaluation, and risk response are the four fundamental steps of effective risk management. The Crobach Alpha test was used to assess the consistency and reliability of the data, and the result was 0.814, indicating that the data is suitable for use. Only one of the twenty indicators, which were divided into four groups for risk management, was weak according to outliers and communalities tests. The risk management process was accurately described by another 20 factors. Total variance extraction yielded a rate of 57.130 percent, which was higher than the required 50%. As a result, the risk management procedure investigated in this study may be useful for effectively managing risks in the UAE police force

Green Weight

Green-weight is a novel system designed to supply a high-rise building with all its needs of electricity using wind energy and to supplement its lighting needs with natural sunlight. David Fisher has proposed an ingenious method to harness the wind for electricity production in an urban setting. His approach is based on using horizontal wind turbines instead of the typical and esthetically awkward looking vertical wind turbines and to incorporate them within the building structure. In this paper we will present our proof-of-concept study of the proposed system. Based on our prototype design of the wind turbines and overall system analysis. In the second part of our paper we will present our proposed auxiliary lighting system. Our system is designed to collect and transfer the sunlight into the building. We estimate that our auxiliary lighting system will save between 40 to 60% from the power needed to light the building during daytime. Another very importantly aspect of our lighting system is the proven fact that natural lighting enhances the living experience of the building occupants (for example, to combat psychological seasonal disorders)

Beyond the Present Constraints That Prevent a Wide Spread of Tissue Engineering and Regenerative Medicine Approaches

Despite the success of tissue engineered medical products (TEMPs) in preclinical translational research, very few have had success in the clinical market place. This gap, referred to as the “valley of death” is due to the large number of ventures that failed to attract or retain investor funding, promotion, and clinical acceptance of their products. This loss can be attributed to a focus on a bench to bedside flow of ideas and technology, which does not account for the multitude of adoption, commercial, and regulatory constraints. The implementation of an alternative bedside to bench and back again approach permits investigators to focus on a specific unmet clinical need, defining crucial translation related questions early in the research process. Investigators often fail to accurately identify critical clinical adoption criteria due to their focus on improved patient outcomes. Other adoption criteria (such as price, time, ethical concerns, and place in the workflow) can cause a product to fail despite improved patient outcomes. By applying simplified business principles such as the build-measure-learn loop and the business model canvas to early-stage research projects, investigators can narrow in on appropriate research topics and define design constraints. Additionally, 86% of all clinical trials fail to result in Federal Drug Administration approval, resulting in significant economic burdens. On the reverse side, approval through the European Medical Agency is widely considered to be more direct but has its challenges. The Committee for Advanced Therapies within the European Medical Agency has received 22 market authorization applications for advanced therapy medicinal products, of which only 10 received authorization. A thorough understanding of the various regulatory pathways permits investigators to plan for future regulatory obstacles and potentially increase their chances of success. By utilizing a bedside to bench and back again approach, investigators can improve the odds that their research will have a meaningful clinical impact